INSOLVENCY AND BANKRUPTCY BOARD OF INDIA CERTIFICATE OF REGISTRATION IP REGISTRATION NO. __
[Under Regulation 7 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016] 1. In exercise of the powers conferred by Regulation 7 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 the Board hereby grants a certificate of registration to [insert name], to act as an insolvency professional in accordance with these Regulations. 2. This certificate shall be valid from [insert start date]. Sd/- (Name and Designation) For and on behalf of Insolvency and Bankruptcy Board of India Place: Date: 103[ FORM C [Under regulation 12 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016] To The Executive Director (IPE Division) Insolvency and Bankruptcy Board of India (IBBI) Subject: Application for recognition as an insolvency professional entity. Sir/Madam, I, having been duly authorised for the purpose, hereby apply, on behalf of [name of the applicant entity], having registered address at [registered address of the applicant], forrecognition as an insolvency professional entity under sub-regulation (2) of regulation 12 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. The details of the applicant and its directors / partners are as under: A. DETAILS OF APPLICANT 1. Name: 2. Address: i. registered office: ii. principal place(s) of business, if any: 103 Substituted by Notification No. IBBI/2019-20/GN/REG049, dated 25th October, 2019 (w.e.f. 25.10.2019).
| No. the | of the (if | No. as an membership shares / Whole | ||
| director/ director/ available) | insolvency | No. | capital | Time |
| partner | partner | professional (if | contributed Director |
(iii) Unique Document Identification Number of the net worth certificate issued by the Chartered Accountant, if any: (iv) Date of the net worth certificate issued by the Chartered Accountant, if any: 3. Details of shareholding or partner’s contribution in the applicant: (i) In case of Partnership
| Sl. No. | Nameof | Amount (Rs.) of total capital insolvency | % share in Whether partner is an Registration No. as aninsolvency professional, if |
| Partner | capital | contribution professional (Yes / No) applicable |
contribution (1) (2) (3) (4) (5) (6) (ii) In case of Company
| Sl. | Name of Number of | % of Whether | Whether shareholder Registration no. |
| No. (Yes / No) | Shareholder shares held shares shareholder No) | is an insolvency as an insolvencyapplicable |
(1) (2) (3) (4) (5) (6) (7) 5. Whether the applicant was at any time in the past derecognised as an insolvency professional entity. (Yes/No) If yes, please furnish the date of derecognition and ground for derecognition. 6. Whether any disciplinary proceeding has been initiated by the Board (IBBI) or the Insolvency Professional Agency against any director(s) / partner(s), who was/is/are insolvency professional(s). (Yes/No) If yes, please provide details. AFFIRMATION I, on behalf of [name of the applicant entity], affirm that - (i) the applicant is eligible to be recognised as an insolvency professional entity; (ii) none of the directors or partners of the applicant, as the case may be, is a director or partner of another insolvency professional entity.
2. I affirm that the information furnished in this application is correct and complete to the bestof my knowledge and belief. 3. I, on behalf of [name of the applicant entity], undertake to comply with the requirements ofthe Insolvency and Bankruptcy Code, 2016, rules, regulations, guidelines and circulars issued thereunder, and such other terms and conditions as may be imposed by the Board while granting the certificate of recognition. Yours faithfully, Authorised Signatory (Name) (Designation) Place: Date: ATTACHMENTS 1. Copy of Board / Partners’ Resolution authorising the person to make this application and make correspondence with the Board 2. Copy of CIN/LLPIN/Certificate of Registration of the applicant 3. Copy of PAN of the applicant 4. Copy of GST Registration Certificate of the applicant 5. Copy of Memorandum of Association/LLP Agreement/Registered Partnership Deed of the applicant 6. Copy of certificate of net worth issued by the Chartered Accountant, if any 7. Copy of Financial Statements of the applicant (including Provisional Financial Statements, as on same date on which net worth of applicant has been submitted) 8. Copy of Certificate of Registration issued by the Board to IPs who are directors or partners, as the case may be, of applicant 9. Evidence of deposit / payment of fee, along with GST, as required under regulation 12(2) of IP Regulations.]